Human milk oligosaccharides promote the growth of staphylococci.

Human milk oligosaccharides (HMO), which constitute a major component of human milk, promote the growth of particular bacterial species in the infant's gastrointestinal tract. We hypothesized that HMO also interact with the bacterial communities present in human milk. To test this hypothesis, two experiments were conducted. First, milk samples were collected from healthy women (n = 16); culture-independent analysis of the bacterial communities was performed, HMO content was analyzed, and the relation between these factors was investigated. A positive correlation was observed between the relative abundance of Staphylococcus and total HMO content (r = 0.66). In a follow-up study, we conducted a series of in vitro growth curve experiments utilizing Staphylococcus aureus or Staphylococcus epidermidis and HMO isolated from human milk. HMO exhibited stimulatory effects on bacterial growth under various nutritional conditions. Analysis of culture supernatants from these experiments revealed that HMO did not measurably disappear from the culture medium, indicating that the growth-enhancing effects were not a result of bacterial metabolism of the HMO. Instead, stimulation of growth caused greater utilization of amino acids in minimal medium. Collectively, the data provide evidence that HMO may promote the growth of Staphylococcus species in the lactating mammary gland.

The effects of soy milk and isoflavone supplements on cognitive performance in healthy, postmenopausal women.

RATIONALE: The decline in estrogen concentrations in women after menopause can contribute to health related changes including impairments in cognition, especially memory. Because of the health concerns related to hormone replacement therapy (HRT), alternative approaches to treat menopausal symptoms, such as nutritional supplements and/or diet containing isoflavones, are of interest. OBJECTIVES: This study investigated whether soy isoflavones (soy milk and supplement) could improve cognitive functioning in healthy, postmenopausal women. PARTICIPANTS, INTERVENTION AND DESIGN: A total of 79 postmenopausal women, 48-65 years of age, completed a double-blind, placebo-controlled trial in which they were randomly assigned to one of three experimental groups: cow's milk and a placebo supplement (control); soy milk and placebo supplement (soy milk, 72 mg isoflavones/day); or cow's milk and isoflavone supplement (isoflavone supplement, 70 mg isoflavones/day). MEASUREMENTS: Cognitive functioning was assessed using various cognitive tasks before the intervention (baseline) and after the intervention (test). RESULTS: In contrast to predictions, soy isoflavones did not improve selective attention (Stroop task), visual long-term memory (pattern recognition), short-term visuospatial memory (Benton Visual Retention Test), or visuo-spatial working memory (color match task). Also, the soy milk group showed a decline in verbal working memory (Digit Ordering Task) compared to the soy supplement and control groups. CONCLUSION: Soy isoflavones consumed as a food or supplement over a 16-week period did not improve or appreciably affect cognitive functioning in healthy, postmenopausal women.

A Randomized Clinical Trial Evaluating rh-FGF-2/ß-TCP in Periodontal Defects.

Biological mediators have been used to enhance periodontal regeneration. The aim of this prospective randomized controlled study was to evaluate the safety and effectiveness of 3 doses of fibroblast growth factor 2 (FGF-2) when combined with a ß-tricalcium phosphate (ß-TCP) scaffold carrier placed in vertical infrabony periodontal defects in adult patients. In this double-blinded, dose-verification, externally monitored clinical study, 88 patients who required surgical intervention to treat a qualifying infrabony periodontal defect were randomized to 1 of 4 treatment groups-ß-TCP alone (control) and 0.1% recombinant human FGF-2 (rh-FGF-2), 0.3% rh-FGF-2, and 0.4% rh-FGF-2 with ß-TCP-following scaling and root planing of the tooth prior to a surgical appointment. Flap surgery was performed with EDTA conditioning of the root prior to device implantation. There were no statistically significant differences in patient demographics and baseline characteristics among the 4 treatment groups. When a composite outcome of gain in clinical attachment of 1.5 mm was used with a linear bone growth of 2.5 mm, a dose response pattern detected a plateau in the 0.3% and 0.4% rh-FGF-2/ß-TCP groups with significant improvements over control and 0.1% rh-FGF-2/ß-TCP groups. The success rate at 6 mo was 71% in the 2 higher-concentration groups, as compared with 45% in the control and lowest treatment groups. Percentage bone fill in the 2 higher-concentration groups was 75% and 71%, compared with 63% and 61% in the control and lowest treatment group. No increases in specific antibody to rh-FGF-2 were detected, and no serious adverse events related to the products were reported. The results from this multicenter trial demonstrated that the treatment of infrabony vertical periodontal defects can be enhanced with the addition of rh-FGF-2/ß-TCP (ClinicalTrials.gov NCT01728844).

Safflower oil consumption does not increase plasma conjugated linoleic acid concentrations in humans.

Conjugated linoleic acid (CLA) is a mixture of positional and geometric isomers of linoleic acid (LA) with conjugated double bonds. CLA has anticarcinogenic properties and has been identified in human tissues, dairy products, meats, and certain vegetable oils. A variety of animal products are good sources of CLA, but plant oils contain much less. However, plant oils are a rich source of LA, which may be isomerized to CLA by intestinal microorganisms in humans. To investigate the effect of triacylglycerol-esterified LA consumption on plasma concentrations of esterified CLA in total lipids, a dietary intervention (6 wk) was conducted with six men and six women. During the intervention period a salad dressing containing 21 g safflower oil providing 16 g LA/d was added to the subjects' daily diets. Three-day diet records and fasting blood were obtained initially and during dietary and postdietary intervention periods. Although LA intake increased significantly during the dietary intervention, plasma CLA concentrations were not affected. Plasma total cholesterol and LDL-cholesterol concentrations were significantly lower after addition of safflower oil to the diet. In summary, consumption of triacylglycerol-esterified LA in safflower oil did not increase plasma concentrations of esterified CLA in total lipids.

Selenium status of infants is influenced by supplementation of formula or maternal diets.

Plasma selenium of infants fed proprietary formula was significantly less than that in infants fed human milk. Addition of selenite to the formula (0.253 mumol Se/L) increased plasma selenium and activities of glutathione peroxidase (GPx) and total peroxidase (Px). However, erythrocyte selenium decreased significantly during the 12-wk study in infants receiving human milk or formula with or without supplemental selenite. Infants fed human milk from women receiving 0 or 200 micrograms supplemental selenium as selenomethionine or selenium-enriched yeast had plasma selenium that paralleled changes in their selenium intake. Plasma GPx and Px activities were unrelated to human milk selenium intake. Milk from women given either selenium supplement prevented the decline in infant erythrocyte selenium. Results of these studies suggest that the method of feeding modifies the infant's apparent selenium status and that the molecular form of selenium provided and/or its interaction with other milk constituents are determinants of infant selenium status.

Selenium status of lactating women is affected by the form of selenium consumed.

The impact of providing selenomethionine (2.7 mumol Se) or selenium-enriched yeast (2.9 mumol Se) on the selenium status of lactating and nonlactating women with customary intakes of approximately 1.3 mumol Se/d was studied. Plasma selenium declined in unsupplemented lactating women but not in nonlactating women. Selenomethionine increased plasma selenium in both lactating and nonlactating women whereas selenium-enriched yeast increased plasma selenium only in nonlactating women. Erythrocyte selenium concentration was not significantly modified by lactation. Plasma glutathione peroxidase (GPx) activity decreased with duration of lactation in unsupplemented women and selenomethionine or selenium-enriched yeast supplementation prevented the decline. Milk selenium declined markedly for 20 wk after parturition in unsupplemented women. Selenomethionine significantly increased milk selenium concentrations whereas selenium-enriched yeast prevented a decline. These results clearly show that the source of selenium provided to lactating women can significantly influence selected indexes of selenium status, including milk selenium concentration.

Nutritional status and behavior during lactation.

Effects of chronic maternal food restriction and time of day on maternal and pup behaviors were examined in ovariectomized Sprague-Dawley rats (n = 26). Dams were fed ad lib (AL) or were restricted to 85% (85 AL) or 70% (70 AL) of ad lib intake. Dams and their 5-pup litters were observed for 45 min at night on days 9, 14, and 19 of lactation and during the day on day 14. A novel behavioral instrument was used to observe maternal and pup behaviors. At night, food-restricted animals engaged in more nursing behaviors than AL animals. Differential pup stimuli may account for this difference. AL animals engaged in more nursing behaviors during the day than night, whereas 70 AL animals demonstrated the opposite diurnal pattern. Time of feeding may explain this difference. On the other hand, 85 AL animals behaved similarly during the day and at night. Therefore, alterations in circadian behavior patterns are less pronounced in rats mildly restricted (85 AL) than in rats more food restricted (70 AL).

Food restriction, gonadotropins, and behavior in the lactating rat.

This study sought to quantify effects of undernutrition on behaviors and to relate these to gonadotropin and prolactin concentrations in the lactating dam. Dams were studied in a 2 x 3 factorial design with litter size and food intake as the two factors. Behavioral data were collected from each dam and her litter on day 9, day 14, and day 19 of lactation, and maternal blood samples collected. Plasma was analyzed for luteinizing hormone, follicle stimulating hormone and prolactin. On day 15 of lactation, percent time nursing, number of pups actively nursing, total number of pups nursing and dam location acted as mediating factors of the effect of diet group on plasma luteinizing hormone concentration. No such relationships were seen for plasma follicle stimulating hormone, and only nest condition score appeared to be a mediator for plasma prolactin concentration. In conclusion, this analysis suggests that food restriction indirectly influences plasma concentration of luteinizing hormone, but not follicle stimulating hormone, by changing maternal and pup behaviors. The relationship among diet, behavior and circulating prolactin was less clear.

Prognosis versus actual outcome: a long-term survey of 100 treated periodontal patients under maintenance care.

One hundred treated periodontal patients under maintenance care were evaluated for 5 years, and 39 of these patients were followed for 8 years to determine the accuracy of assigned prognoses based on commonly taught clinical criteria. The results suggested that this population reflected many of the same characteristics seen in well-maintained patients. The ultimate fate of teeth initially labeled as hopeless varied substantially, and even though the average prognosis of the teeth studied at each interval remained relatively stable over time, individual prognosis categories and individual tooth prognoses changed frequently. Possible reasons for these shifts are discussed. In conclusion, it was found that projections were ineffective in predicting any prognosis other than good, and that prognoses tended to be more accurate for single rooted teeth than for multi-rooted teeth. Further evaluation of the data is needed to determine how each of the prognostic indicators relate to the success or failure of our projection.

Prognosis versus actual outcome. III. The effectiveness of clinical parameters in accurately predicting tooth survival.

Tooth loss for 100 treated periodontal patients (2,509 teeth) under maintenance care was evaluated to determine the effectiveness of commonly taught clinical parameters utilized in the assignment of prognosis in accurately predicting tooth survival. Previous studies in this series evaluated prognosis as a surrogate variable representing the condition of the tooth at a particular point. In this study, survival analysis was used to evaluate the relationship of these common clinical parameters to an actual end point, tooth loss. Robust log rank tests indicated that initial probing depth, initial furcation involvement, initial mobility, initial crown-to-root ratio, and initial root form were all associated with tooth loss. In addition, smoking and increased initial bone loss were both found to be associated with increased risk of tooth loss while fixed abutment status was associated with a decreased risk of tooth loss. A Cox proportional hazards regression model showed that initial probing depth, initial furcation involvement, initial mobility, initial percent bone loss, presence of a parafunctional habit without a biteguard, and smoking were all associated with an increased risk of tooth loss. This model suggests that patients are twice as likely to loose their teeth if there is increasing mobility, if they have a parafunctional habit and do not wear a biteguard, or if they smoke. From these data there does appear to be a relationship between the assigned prognosis and tooth loss. Teeth with worse prognosis have a worse survival rate, but the commonly taught clinical parameters used in the traditional method of assignment of prognosis do not adequately explain that relationship. Furthermore, initial prognosis did not adequately explain the condition of the tooth or accurately predict the tooth's survival. These results seem to indicate that the effect of these clinical parameters on tooth survival is only partially reflected in the assigned prognosis initially, suggesting that perhaps some of the clinical parameters should be weighed more heavily than others when assigning prognosis. Further studies are needed to develop a more accurate method for the assignment of prognosis.

Prognosis versus actual outcome. II. The effectiveness of clinical parameters in developing an accurate prognosis.

The assignment of prognosis is one of the most important functions undertaken in clinical practice, yet there is little evidence to support the current decision-making process which is based on an outdated model of disease etiology and progression. This study evaluated 100 treated periodontal patients (2,484 teeth) under maintenance care for 5 years, with 38 of these patients followed for 8 years, to determine the relationship of assigned prognoses to the clinical criteria commonly used in the development of prognosis. The method of generalized estimating equations (GEE) for correlated data was utilized to determine the relationship of each clinical factor to the assignment of initial prognosis, improvement in prognosis at 5 years, and worsening in prognosis at 5 years. A multiple linear regression model was constructed for predicting initial prognosis based on initial clinical data. Increased probing depth, more severe furcation involvement, greater mobility, unsatisfactory crown-to-root ratio, malpositioned teeth, and teeth used as fixed abutments resulted in worse initial prognoses. The coefficients from this model were able to predict accurately the 5-year and 8-year prognoses 81% of the time. When teeth with "good" prognoses were excluded, the predictive accuracy dropped approximately 50%. Multiple logistic regression models indicated that improvement in prognoses and worsening in prognoses were both strongly associated with initial probing depth, initial furcation involvement, initial tooth malposition, and smoking when adjusted for initial prognosis. In addition, good hygiene was found to increase the probability of improvement in prognosis while initial mobility was found to decrease the likelihood of improvement in prognosis. Neither of these factors was found to be significant in worsening of prognosis. Smoking decreased the likelihood of improvement by 60% and doubled the likelihood of worsening in prognosis at 5 years. The results of this study indicate that some clinical factors used in the assignment of prognoses are clearly associated with changes in clinical condition over time. The data also demonstrated that the traditional approach for assigning prognoses is ineffective for teeth with an initial prognosis of less than good. Since most periodontally involved teeth are compromised, further work should include the development of a more effective method for assigning prognoses that is based on clear, objective clinical criteria.

Prognosis versus actual outcome. IV. The effectiveness of clinical parameters and IL-1 genotype in accurately predicting prognoses and tooth survival.

BACKGROUND: Recently, a genetic marker (IL-1 genotype) that identifies individuals at higher risk for developing severe periodontal disease was discovered. A subgroup of the population reported on earlier was evaluated to determine if knowledge of the patient's IL-1 genotype would improve accuracy in assignment of prognoses and prediction of tooth loss. METHODS: This subgroup consisted of 42 patients (1,044 teeth) in maintenance care for 14 years; 16 tested IL-1 genotype-positive (IL-1GP). Nine were smokers, and 30 had a history of smoking, with an average of 29.44 pack years. A multiple Cox regression model and Kaplan-Meier survival plots were fit to the subset of patients to evaluate tooth loss. RESULTS: Both IL-1GP and heavy smoking were significantly related to tooth loss. A positive IL-1 genotype increased the risk of tooth loss by 2.7 times, and heavy smoking by 2.9 times. The combined effect of IL-1GP and heavy smoking increased the risk of tooth loss by 7.7 times. The value of clinical parameters traditionally used to assign prognosis was found to be dependent on IL-genotype and smoking status. In the model that included IL-1 genotype and heavy smoking, none of the clinical parameters added significantly to the model for tooth loss while mobility, probing depth, crown-to-root ratio, and percent bone loss added significantly to the model, which included IL-1 genotype in non-smokers. IL-1GP patients and patients who smoked heavily demonstrated a much worse tooth survival rate when compared to IL-1 genotype-negative patients and non-smokers, respectively. CONCLUSIONS: Knowledge of the patient's IL-1 genotype and smoking status will improve the clinician's ability to accurately assign prognosis and predict tooth survival. Clinical implications are as follows. Investigators were unable to judge which patients would be IL-GP or negative based on their clinical presentation or family history of tooth loss due to periodontal disease. Since periodontal diseases are multifactorial, knowledge of the patient's genotype is more important in predicting future risk than explaining past disease. Knowledge of IL-1 genotype status would be important in developing a treatment plan and predicting tooth survival for a new patient who smokes and presents with periodontal disease, especially if restorative care is needed. Knowledge of a maintenance patient's IL-1 status would help target therapy for non-responding areas; one would be less likely to take a "wait and see approach" with IL-1GP patients. IL-1 positive non-smokers can be successfully treated and maintained over long periods of time.

Tetracycline fibers plus scaling and root planing versus scaling and root planing alone: similar results after 5 years.

This paper presents 5-year data pertaining to a subgroup of patients from a previous investigation who were treated with scaling and root planing plus tetracycline fibers. The parent study demonstrated that 6 months after therapy, scaling and root planing plus tetracycline fiber therapy was significantly better at reducing probing depth and gaining clinical attachment than scaling and root planing alone. However, the long-term data presented here show a regression from the original gains in clinical attachment levels in the fiber group. Ultimately, the use of fibers provided no significant advantage with regards to probing depth reduction or clinical attachment gain. Within the power of this study, which would have required 1.78 mm of change in clinical attachment to show a difference, there was no significant difference between the treatments at 5 years. This study underscores the need for additional long-term evaluation of this mode of therapy.

Evaluation of an oral disease control program administered to a clinic population at a suburban dental school.

This study included 99 patients. Seventy-four of these participated in the Oral Disease Control program at Emory University School of Dentistry and 25 control patients did not. Those who completed the Oral Disease Control program were examined and scored from 2 to 24 months afterward. The Patient Hygiene Performance Scoring was used. It was found that there was no significant difference in levels of plaque between subjects who completed the Oral Disease Program and those who did not participate. Also, the patient's knowledge of the causes of dental caries and gingival disease bore no significant relationship to the amount of plaque present. Further, certain selected hygiene habits had no significant effect on plaque level. The patients studied were enthusiastic about the control program and developed an increased awareness of oral disease control. However, this study confirms others that demonstrate the need for repeated professional reinforcement in any effective oral disease control program.

High-fat dairy product consumption increases delta 9c,11t-18:2 (rumenic acid) and total lipid concentrations of human milk.

Conjugated octadecadienoic acids (18:2, conjugated linoleic acids) have been shown to be anticarcinogenic and may influence growth and nutrient partitioning. The delta 9c,11t-18:2 isomer (rumenic acid, RA) is most common in both food sources and human tissues. To determine if maternal diet can influence milk RA concentration, breastfeeding women (n = 16) were enrolled in a 3-wk crossover study. Women initially consumed minimal amounts of food containing RA during week 1, then were assigned randomly to consume diets rich in high-fat dairy foods (and thus RA) during week 2 or 3. Milk was collected by complete breast expression twice during each experimental week. Current and chronic RA intakes were estimated by 3-d dietary records and food frequency questionnaires, respectively. Estimated chronic RA intakes ranged from 49 to 659 mg/d. Dietary RA intake was greater during the high compared to the low dairy period (291 +/- 75 vs. 15 +/- 24 mg/d, respectively; P < 0.0001). Milk contained more RA during the high than the low dairy period (13.5 +/- 0.1 vs. 8.2 +/- 0.4 mumol/g lipid, respectively; P < 0.0001). Milk lipid concentration was influenced by diet, such that lipid concentration was greater during the high than the low dairy period (46.6 +/- 5.0 vs. 38.3 +/- 1.6 mg/g milk, respectively; P < 0.05). Additionally, multiple regression analyses suggested that body mass index was the primary predictor of milk RA and lipid concentrations. In summary, these data indicate that both lipid and RA concentrations of human milk can be influenced by diet.

Documentation of second-by-second breastfeeding behaviors using a novel method.

The specific way nursing patterns influence the duration of postpartum amenorrhea is unknown. This may result from the shortcomings of available methods: the daily log and recall. We tested these against a novel method, an event monitor (EM), consisting of a wrist-worn stopwatch that stores events. Exclusively breastfeeding women (n = 11) were assigned randomly to use each of the three methods twice during a 2-week period surrounding Weeks 4, 8, and 12 postpartum. More nursing episodes were recorded with the EM than log during Week 4 (p < 0.03) and Week 8 (p < 0.02). EM captured more episodes than recall during all study periods (p < 0.004). The EM was considered as acceptable and accurate to mothers as the other methods and, therefore, is a useful option for documenting breastfeeding patterns.

Coverage of the denuded root surface using the free soft tissue autograft.

This paper presents a new soft tissue graft technique that allows the surgeon not only to increase the zone of attached gingiva, but also to cover previously denuded root surfaces. Predictability of the procedure is discussed and the results are related to the health of the periodontium and to the patient's self-image.

Periodontal plastic surgery.

Most periodontal esthetic procedures can be grouped into one of the following areas: crown lengthening, alveolar ridge preservation/augmentation, soft tissue grafts, and the correction of an open interproximal space. Soft tissue abnormalities, with the exception of the loss of the interproximal papilla, can be resolved predictably, improving esthetics and even creating restorative opportunities. In addition to a discussion of the pretreatment esthetic evaluation, an overview of periodontal plastic surgery procedures is presented, along with an example of the "Periodontal Enhancement Prescription," which facilitates communication between offices.

Reconstruction of bone on facial surfaces: a series of case reports.

To rebuild the damaged periodontium to its original form, it would be ideal not only to cover the denuded root surfaces with soft tissue, but also to reconstruct the cortical plate. This paper presents four cases in which osseous grafts and guided tissue regeneration, along with root surface conditioning, were used to encourage growth of new facial bone. Some degree of success was achieved in each case.

Soft tissue augmentation on previously restored root surfaces.

Three cases are presented demonstrating that soft tissue augmentation procedures can be accomplished on previously restored root surfaces. Diagnostic techniques to help determine ideal tooth length are discussed, and clinical examples of how to surgically manage the previously restored root surfaces are presented.